High remission rates from an initial ultra-high risk state for psychosis

To investigate the proportion of patients among subjects initially identified as fulfilling the ultra-high risk (UHR) criteria for psychosis using the Scale of Prodromal Symptoms (SOPS) who fully remitted after one year.

Seventy-two patients between 14 and 40 years who were referred to the Bruderholz Early Psychosis Outpatient Service in Switzerland and who met UHR criteria were included in the present study. At 1-year follow-up, data for 52 patients were available. Patients with transition to psychosis and patients with sustained UHR criteria were defined as 'cases', and patients with remission from UHR criteria as 'non-cases'. We compared clinical and socio-demographic characteristics between these two patient groups at baseline.

13.5% of the patients converted to full-blown psychosis within one year, one quarter displayed sustained UHR criteria, and 59.2% of the patients fully remitted from the initial UHR status. Outcome was independent of medication or treatment status. 'Cases' and 'non-cases' did not differ significantly on socio-demographic and clinical variables at baseline.

The chance of remission to a non-risk state was over fourfold higher than the chance of conversion to psychosis within a year of establishing UHR status. Our data underline that the commonly used symptoms to identify UHR patients are often transitory and may not capture the stable core of developing psychosis. This highlights the danger of provoking anxiety and stigmatization in mislabeled individuals and missing true at-risk patients who present features of the psychosis core, but who do not yet-or maybe never will-manifest positive symptoms.